tbuckley/cabot-search huggingface dataset:
Clinical utility of plasma ctDNA sequencing in metastatic urothelial carcinoma.
Authors: Clara Helal, Cedric Pobel, Arnaud Bayle, Damien Vasseur, Claudio Nicotra, Felix Blanc-Durand, Natacha Naoun, Alice Bernard-Tessier, Anna Patrikidou, Emeline Colomba, Ronan Flippot, Alina Fuerea, Nathalie Auger, Maud Ngocamus, Benjamin Besse, Ludovic Lacroix, Etienne Rouleau, Santiago Ponce Aix, Antoine Italiano, Yohann Loriot
Journal: Journal of Clinical Oncology (2023)

4576 Background: Genomic stratification may help to improve the management of patients with metastatic urothelial cancer (mUC) given the recent identification of targetable molecular alterations in this disease. However, collecting tissue samples in mUC remains challenging. We assessed the clinical utility of plasma circulating tumor DNA (ctDNA) sequencing in mUC. Methods: mUC patients were prospectively enrolled in the STING trial (NCT04932525) whereby ctDNA was profiled using the FoundationOne Liquid CDx Assay (324 genes, tumor mutational burden [TMB], microsatellite instability status). Each individual genomic report was reviewed and discussed weekly by a multidisciplinary tumor board (MTB). Actionable targets were classified by ESCAT tier leading to molecular-based treatment suggestions whenever it was possible. Results: Between January 2021 and June 2022, 140 mUC patients underwent molecular profiling. Median time to assay results was 20 days. ctDNA abundance was correlated with number of prior lines and number of metastatic sites. ctDNA analysis reproduces the somatic genomic landscape reported by previous tissue-based cohorts. Concordance for serial tumor tissue was moderate (r=0.545 CI95: [0.121-0.801], p= 0.016). At least one actionable target was detected in 63 patients (45 %) with a total of 35 actionable alterations including TMB high (≥12 mutations/Mb) (N= 39, 21.1%), FGFR3 (N= 20, 10.8%) and HRD alterations (N= 14, 7.6%). The MTB recommended a matched therapy for 63 patients (45.0%). In total, 8 patients (5.7 %) were treated with an overall response rate of 50% (95%: 15.70-84.30) and a median PFS of 5.2 months (CI95%: 4.1 - NR). FGFR3 alterations were associated with lower progression-free survival in patients treated with immunotherapy. Conclusions: Overall, our analysis demonstrates that genomic profiling with a large panel of ctDNA in mUC is a reliable and feasible approach to timely initiate genotype-matched therapies. Clinical trial information: NCT04932525 .
Role of HLA class-I antigen peptide loading complex components in immune evasion and treatment sensitivity in human lung cancer.
Authors: Adrien Costantini, Kishu Ranjan, Soldano Ferrone, Kurt A. Schalper
Journal: Journal of Clinical Oncology (2023)

2623 Background: Determinants of sensitivity and resistance to immune checkpoint inhibitors (ICIs) are poorly understood. An intact HLA class-I antigen presentation machinery (APM) is necessary for tumor-antigen recognition by effector T-cells and disruptions to the APM can cause ICI resistance. The peptide loading complex (PLC) is a multi-chaperone complex located in the endoplasmic reticulum in which tapasin (Tap), calreticulin (CalR) and ERp57 play major roles. The PLC allows for optimal peptide selection and loading onto HLA class-I heavy chain and is critical for adequate cell surface presentation of peptide-HLA complexes. We studied the frequency and clinical significance of cancer-cell selective PLC protein defects in human NSCLC. Methods: Multiplex quantitative immunofluorescence (mQIF) was performed to simultaneously and spatially measure cytokeratin (CK), Tap, CalR, ERp57 and CD8 protein levels in 1,031 primary NSCLCs from 5 independent cohorts represented in tissue microarrays. The protein levels were measured in CK-positive cancer-cells and in CK-negative stromal cells. The presence of lower marker levels in malignant cells relative to stromal cells within the same sample was considered as cancer-cell selective downregulation. Cohorts #1-3 included baseline samples from patients treated without ICIs and Cohort #4 included samples from patients treated with ICIs. Cohort #5 contained lung adenocarcinomas clinically tested for EGFR and KRAS mutations. The association between the levels of Tap, CalR and ERp57, their association with clinicopathologic variables, CD8+ T-cell levels and outcomes were studied. Results: mQIF analysis identified cancer-cell selective downregulation of Tap, CalR and/or ERp57 in 73%, 81%, 68% and 75% of cases from Cohorts #1-4, respectively. The most common PLC alterations were cancer-cell downregulation of Tap alone in Cohorts #1 (32%), #3 (34%) and #4 (36%); and Tap-CalR in Cohort #2 (29%). Tap and ERp57 levels were significantly higher in stage IV than in earlier stage tumors. The PLC marker levels and the frequency of cancer-cell selective downregulation were comparable across EGFR and KRAS mutated samples. NSCLCs with cancer-cell Tap downregulation had lower CD8+ T-cell infiltration and shorter OS across all cohorts that reached statistical significance in Cohort #4 (median OS 12.08 vs 21.00, HR=1.72, 95% CI 1.02-2.89, p=0.034). The cancer-cell selective downregulation of CalR was associated with shorter OS in cohorts #1 and #3. Conclusions: HLA class-I PLC components show variable levels in treatment naïve NSCLCs. Downregulation of Tap in cancer-cells, alone or in combination with other PLC members occurs in up to 60% of cases and is associated with reduced CD8+ TILs and shorter OS preferentially in patients treated with ICIs. Cancer-cell Tap downregulation could mediate primary ICI resistance and has biomarker potential.
The effect of megestrol acetate ± pterostilbene in endometrial cancer: A prospective, randomized, window-of-opportunity clinical trial.
Authors: Rosemary Senguttuvan, Paul Henry Frankel, Nora Ruel, Mehdi Kebria, Ernest Soyoung Han, Mihae Song, Maria De Leon, Marta Invernizzi, Melissa Eng, Raechelle Tinsley, Aimin Li, Daniel Schmolze, Sue Chang, Javier Arias Stella, Thanh Hue Dellinger
Journal: Journal of Clinical Oncology (2023)

5597 Background: Pterostilbene (3,5-dimethoxy-40-hydroxystilbene) is a potent oral antioxidant found naturally at highest concentrations in blueberries. Its anti-tumor effects in preclinical studies of various solid tumors include carcinogenesis, inflammation, reactive oxygen species (ROS) formation, and antiproliferative effects. In endometrial cancer (EC), in vitro and in vivo studies demonstrated a synergistic antiproliferative effect of pterostilbene (PT) in combination with megestrol acetate (MA). No clinical trials testing the potential therapeutic benefit of pterostilbene in cancer have been completed. Methods: We performed a prospective, window-of-opportunity, randomized phase 2 clinical trial (NCT03671811) in patients with EC. Eligible patients had to be surgical candidates for treatment with hysterectomy and not have received prior therapy. The primary objective was to determine the effect of MA plus PT versus standard treatment of MA alone on tumor proliferation as measured by the Ki-67 index during the preoperative window. Patients were randomized 1:1 to one of two arms: MA+PT PO BID versus MA PO BID, for 3 weeks. The Ki-67 index was measured via hot-spot and H-score methodology in the preoperative tumor and hysterectomy specimen by two blinded pathologists whose measurements were averaged. The net change between pre- and post-operative specimens was calculated for each patient and expressed as a percentage. Toxicity was assessed using CTCAE grading. Results: A total of 44 patients with EC of all histologies were recruited to the study and included in the toxicity analysis. Median age was 61.9 years. Baseline demographics were comparable between both arms. Median treatment duration was 21 days (14-56), similar in both arms. One G3 hypertension was encountered in the MA arm; one G3 thromboembolic event in the MA+PT arm. Of 35 patients with sufficient treatment duration (&gt;10 days) and available pre-and post-treatment specimens, 29 patients with endometrioid histology were evaluated for the ki67 analysis: 14 in the MA arm and 15 in the MA+PT arm. The MA+PT group demonstrated a -41.1% change in Ki-67 index by Hot Spot Score compared to -27.5% in the MA-only group (p=0.17). A similar trend was observed for the Ki-67 index by H Score methodology (-41.6% vs -26.7%, MA+PT vs MA, p=0.17). Conclusions: The combination of MA + PT in preoperative treatment of endometrial adenocarcinoma is well tolerated. The addition of Pterostilbene demonstrates a trend towards decreased Ki-67 index in endometrioid EC patients. Molecular studies are pending to delineate biomarkers associated with response. Clinical trial information: NCT03671811 .
Immunomodulatory AVM0703 enhances R-CHOP anti-lymphoma effect with reduced toxicity: Immune-resistant, aggressive A20 lymphoma model.
Authors: Theresa Deisher, Sandeep Mittal, Spencer Sawas, Elizabeth Patterson, Evan Nakamura, Peter Jarzyna
Journal: Journal of Clinical Oncology (2023)

e14583 Background: Rituximab-cyclophosphamide-doxorubicin-vincristine-prednisone (RCHOP) is the standard of care for most aggressive B-cell lymphomas. RCHOP requires numerous treatment cycles, typically 6, with challenging side effects, including toxicity and long-term secondary malignancies. Trials have demonstrated that 4 cycles of RCHOP was non-inferior to 6 with similar secondary malignancies, however, real world experience has demonstrated that long term outcomes are superior when patients achieve minimal residual disease negative (MRD-) status after the 3 rd cycle (1,2). Addition of a novel agent to RCHOP that could reduce the number of cycles to 3 while maintaining response, could overcome the long-term side-effects and allow frail and elderly patients to receive full dose RCHOP in each cycle to improve outcomes. For example, addition of Lenalidomide with RCHOP improved outcomes in ABC-DLBCL patients (3), but leads to therapy related myeloid neoplasm in recent studies (4). AVM0703, an immunomodulatory drug, mobilizes bispecific and i-TCR double-positive NKT cells (AVM_NKT). In the aggressive, immune resistant A20 mouse lymphoma model, neoadjuvant AVM0703 was additive/synergistic, when cyclophosphamide/fludarabine (CyFlu) was dosed 3 + 24 hours later, with no additional toxicities. Therefore, we hypothesized that combining AVM0703 with RCHOP would be an effective and well tolerated treatment of DLBCL. Methods: Tumor-bearing mice were made by sc flank injection of 2x10 6 murine A20 B-cells in 10-week-old Balb/c mice. When tumor size reached established ~100 mm 3 , 48 mice (1:1 male: female) were randomized (12 mice each cohort) 1) Placebo 2) 1 cycle RCHOP 3) AVM0703 (18mg/kg HED) 4) AVM0703+1 cycle RCHOP combination treated as described previously (5,6). When Placebo tumors reached ~ 2000 mm 3 , all mice were sacrificed and tumors, blood, spleen, bone marrow were analyzed for the presence of remnant A20, and immune cell state by flow cytometer. Results: One RCHOP only mouse died from the chemo. There were no deaths in AVM0703+RCHOP group. Tumor remnant live A20 were significantly reduced in all 3 treatment groups compared to Placebo. Interestingly, AVM0703+RCHOP significantly increased the number of MRD- A20 tumors compared to RCHOP alone. Conclusions: Based on this study we plan to determine whether 3 cycles of AVM0703+RCHOP can induce long term CR and if AVM0703 could replace R and reduce long term side effects. 1) Poeschel Lancet 2019. 2) Spurgeon J Natl Canc Inst 2016. 3) Nowakowski JCO 2021. 4) Sperling Blood 2022. 5) Bascuas J Transl Med 2016. 6) Bongard PLoS Pathog 2019. [Table: see text]
Predictive biomarker for cisplatin in prospective phase 2 of liposomal cisplatin in metastatic breast cancer.
Authors: Dorte Nielsen, Erik Jakobsen, Sven Tyge Langkjer, Hella Danoe, Eva Balslev, Ann Knoop, Iben Kümler, Ida Kappel Buhl, Steen Knudsen, Anker Hansen, Mogens Winkel Madsen, Ulla Hald Buhl, Nils Meland, Knut Smerud, Peter Buhl Jensen, Ulrik Niels Lassen
Journal: Journal of Clinical Oncology (2023)

3130 Background: Heavily pretreated late-stage breast cancer patients of any subtype represent a huge treatment challenge. Cisplatin may work in selected patients but is often disqualified because of toxicity. LiPlaCis is a liposomal formulation of cisplatin in development utilizing the sPLA 2 -triggered targeted release of cisplatin. The prediction of cisplatin efficacy with a 205 mRNA profile has previously been demonstrated in a retrospective study in two NSCLC cancer patient cohorts receiving adjuvant cisplatin 1 . Methods: The dose-escalation part of a phase 1/2 study, of 20 patients with a variety of locally advanced or metastatic solid tumors, suggested a phase 2 dose of LiPlaCis to be 75mg on day 1 and 8 q 3 wks. In this phase 2 part, the cisplatin drug response predictor (DRP) was used to select metastatic breast cancer (mBC) patients with response likelihood scores from FFPE diagnostic or later biopsies. Patients were treated until progression or unacceptable toxicity. Halfway through phase 2 part, the dosing was changed to a per body surface schedule (40 mg/m 2 ) after a fatal event with the flat dosing (in effect 51 mg/m 2 for this patient). Among the 52 patients included in the phase 2 part, we here report data from the 37 patients with mBC platinum naïve, with DRP scores 34-100%, and with RECIST-defined response outcomes. Within this subgroup, we conducted a post hoc analysis of possible DRP cut-off values that could identify patients with a clinically meaningful response to treatment. Results: mBC patients had received a median of 7 previous treatment lines. A DRP score ≥80% (DRP80+) discriminated well between responders and non-responders to liposomal cisplatin. All 4 partial remissions in the study were in the DRP80+ group, and other key efficacy endpoints were in favor of the DRP80+ vs the lower scores (DRP80-). LiPlaCis was generally well tolerated, with a mean of 4.4 treatment cycles administered per patient. Only 1 SAE (pyelonephritis) was reported and considered related to treatment. One patient died whilst on treatment, but due to disease progression. From a total of 164 treatment cycles, 18 of the patients reported 1 grade 4 and 41 grade 3 AEs considered possibly related to treatment. Conclusions: LiPlaCis shows efficacy in heavily pretreated mBC patients, especially when using the DRP method as a companion diagnostic. Further, this is the first clinical study to prospectively validate DRP as a method to identify responders to chemotherapy cisplatin. 1) Buhl et al PLOS One doi: 10.1371/journal.pone0194609. Clinical trial information: NCT01861496 . [Table: see text]
Comparative real-world (RW) evidence on darolutamide (Daro), enzalutamide (Enza), and apalutamide (Apa) for patients (Pts) with nonmetastatic castration-resistant prostate cancer (nmCRPC) in the United States: DEAR.
Authors: Alicia K. Morgans, Neal D. Shore, Nasreen Khan, Niculae Constantinovici, Javeed Khan, Guifang Chen, Julie Xu, Jorge A. Ortiz, Daniel J. George
Journal: Journal of Clinical Oncology (2023)

5097 Background: Novel androgen receptor inhibitors (ARIs) are recommended for pts with nmCRPC. Daro has a distinct structure with low blood-brain barrier penetration which may lead to a lower risk of central nervous system-related adverse events (AEs) and minimal risk of AEs commonly associated with ARIs. DEAR is the first study comparing RW utilization, outcomes, and AEs between daro and enza/apa in nmCRPC pts. Methods: This retrospective chart review cohort study uses electronic medical records from the PPS network of US urology practices. Eligible pts had nmCRPC, no prior novel hormonal therapy, and initiated first ARI treatment (index date) between 8/2019-3/2022. We describe the % of pts who discontinued initial ARI treatment (DISC), % who progressed to metastasis (PROG), and % with AEs. A comparative analysis was performed between daro and enza/apa using Cox proportional hazards models for time to DISC/time to PROG, adjusting for observed baseline (BL) factors. Results: 870 pts were included (daro/enza/apa, n=362/382/126). Median age (80/79/80 y), median BL prostate-specific antigen (PSA) doubling time (6.8/6.4/7.4 mo), other BL characteristics, and median follow-up (22.2/22.7/23.3 mo) were similar for daro/enza/apa. A lower % of pts had a DISC event on daro vs enza/apa (30.4 vs 40.8/46.0) or a PROG event (17.7 vs 28.3/27.8) during the study period. Multivariate analyses adjusting for BL factors showed that pts on daro had a lower risk of DISC and PROG over time vs enza/apa. A lower % of pts on daro had AEs vs enza/apa (24.9 vs 29.3/30.2). Conclusions: Overall, a lower % of pts discontinued initial ARI treatment, progressed to metastasis, or had AEs on daro vs enza/apa. In analyses adjusting for observed BL factors, pts on daro had considerably lower risk of DISC and PROG vs enza/apa. This study confirms daro’s strong efficacy and favorable tolerability profile in a RW setting. The longer treatment duration seen with daro may be associated with a lower risk of progression to mCRPC vs enza/apa. [Table: see text]
Association between targeted cancer drug net health benefit and uptake, patient out-of-pocket spending, and total spending.
Authors: Kelsey S. Lau-Min, Yaxin Wu, Shavon E. Rochester, Justin E. Bekelman, Genevieve P. Kanter, Kelly D. Getz
Journal: Journal of Clinical Oncology (2023)

6644 Background: Targeted cancer drugs (TCDs) have revolutionized oncology, but they are widely variable in their clinical benefit and are often accompanied by high patient-out-pocket (OOP) costs. The ASCO Value Framework uses published clinical trial data on survival, toxicity, and potential for symptom palliation to quantify the net health benefit (NHB) of any given cancer drug. We aimed to evaluate the association between NHB and uptake, patient OOP spending, and total spending for eight oral TCDs approved for the first line treatment of an advanced solid tumor based on one or more clinical trials comparing to a non-TCD control arm. Methods: We conducted a retrospective cohort study of incident pharmacy claims for oral TCDs prescribed to patients aged 18-64 years between 2012-2020 in the nationwide Health Care Cost Institute de-identified commercial claims dataset. NHB scores were calculated for each TCD of interest using the ASCO Value Framework and categorized as high (&gt;60), medium (40-60), and low (&lt;40) net health benefit. Distributions of incident 28-day TCD supplies were plotted over time by NHB category. The primary outcome was patient OOP spending (patient copay + coinsurance + deductible), whereas the secondary outcome was total spending (patient OOP spending + pharmacy reimbursement). Generalized linear models were used to evaluate the association between each outcome of interest and TCD NHB, adjusted for cancer indication. Results: We included 8,524 incident pharmacy claims for eight TCDs with nine indications in breast cancer, non-small cell lung cancer (NSCLC), melanoma, and pancreatic cancer. NHB scores ranged from 7 (erlotinib for pancreatic cancer) to 81 (crizotinib for ALK-rearranged NSCLC), with 1,145 (13%), 6,608 (78%), and 771 (9%) of pharmacy claims falling into low-, medium-, and high-NHB categories, respectively. Medium- and high-NHB TCDs accounted for the majority of incident TCD prescriptions throughout the study period. Median patient OOP spending was $18.78 for the first 28-day TCD supply (IQR $0.00-$87.57), with 45% of patients paying $0 and 8% paying &gt;$1,000 OOP. Patient OOP spending was not significantly associated with TCD NHB category (difference $0.94, 95% CI -$49.99-$51.87 for medium vs low NHB; difference $58.86, 95% CI -$28.04-$145.75 for high vs low NHB). Median total spending was $10,118.79 (IQR $6,365.95-$10,600.37) for an incident 28-day TCD supply. There was a $1,083.56 increase in total spending for each 10-point increase in NHB score (95% CI $1,050.27-$1,116.84, p &lt;0.01 for H0 = $0). Conclusions: Although TCDs are widely variable in their NHB, low-NHB TCDs are not prescribed as frequently as medium- and high-NHB TCDs. Total spending on TCDs is high and positively associated with NHB. Commercially insured patients are largely shielded from high OOP spending on TCDs.
Correlation between biomarkers and treatment outcomes in diverse cancers: A meta-analysis of phase I and II immunotherapy clinical trials.
Authors: Elena Fountzilas, Henry Hiep Vo, Peter Müller, Razelle Kurzrock, Apostolia Maria Tsimberidou
Journal: Journal of Clinical Oncology (2023)

e14638 Background: Many immuno-oncology (IO) trials are conducted without biomarker selection. We performed a meta-analysis of phase I/II clinical trials evaluating immune checkpoint inhibitors (ICIs) to determine the association between biomarkers and clinical outcomes, if any. Methods: We searched PubMed for phase I/II clinical trials of drugs approved by the Food and Drug Administration (labeled, off-label, or combined with investigational ICIs or other treatment modalities) from 2018 to 2020. We compared the objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) between biomarker-positive and biomarker-negative groups, using data from correlative studies. Results: Overall, 174 clinical studies that included 19,178 patients were identified and 131 studies investigated &gt;30 correlative biomarkers, that included PD-L1 expression (≥1%, 111 studies), tumor mutational burden (20 studies), and microsatellite instability/mismatch repair deficiency (10 studies). Overall, 123, 46, and 30 cohorts (drugs, tumor types, or biomarkers) with 11,692, 3,065, and 2,256 patient outcomes for ORR, PFS, and OS, respectively, were analyzed in correlation with biomarkers. Meta-analyses demonstrated that ICIs in patients with biomarker-positive tumors were associated with higher ORR (odds ratio 2.15 [95% CI, 1.79-2.58], p&lt;0.0001); and longer PFS (hazard ratio [HR] 0.55 [95% CI, 0.45-0.67], p&lt;0.0001), and OS (HR 0.65 [95% CI, 0.53-0.80], p&lt;0.0001) compared with those with biomarker-negative tumors. Significance for ORR and PFS was retained in multivariate analysis (p&lt;0.001) (OS, not included owing to the small number of trials reporting OS). Conclusions: Our data suggest that IO biomarkers should be used in patient selection for ICIs. Prospective studies are warranted.